Healthcare Provider Details

I. General information

NPI: 1417612078
Provider Name (Legal Business Name): TAYLOR JOY MARTINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY STE 501
SEATTLE WA
98101-1781
US

IV. Provider business mailing address

14243 NE WOODINVILLE DUVALL RD # 311
WOODINVILLE WA
98072-8564
US

V. Phone/Fax

Practice location:
  • Phone: 206-651-4432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP61229962
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: